Obtain consent, ensure privacy, and have a chaperone present per agency policy before beginning the examination.
Assess vaginal bleeding and discharge by history and inspection as within scope, and treat any postmenopausal bleeding as requiring evaluation.
Assess pelvic pain by history and gentle abdominal examination, noting acuity and any fever.
Inspect a post-operative site or the vaginal cuff area as within scope for bleeding, discharge, or signs of dehiscence.
Assess prolapse and pelvic-floor symptoms and their effect on voiding and bowel function.
Where a pessary is present, assess for comfort, discharge, and the signs of erosion or retention, and provide care per order and scope.
Inspect the vulvar and perineal skin for the signs of a necrotizing infection — disproportionate pain, discoloration, crepitus, and systemic toxicity — and escalate immediately if present.
For heavy bleeding with hemodynamic change, severe pelvic pain with fever, postmenopausal bleeding, or signs of a necrotizing infection, escalate rather than continuing the exam.
